Contents

1. NEWS

When the Technical Review Panel assessed Ethiopia’s recent TB/HIV funding request, it raised concerns about the sustainability of national programs and about gaps in services for key populations. This article summarizes the TRP’s concerns as well as the clarifications provided by Ethiopia’s country coordinating mechanism.

2. NEWS and ANALYSIS

Despite the fact that the Technical Review Panel noted the lack of interventions targeting men who have sex with men, and transgendered persons, when it reviewed Ethiopia’s HIV concept note from the 2014–2016 allocations, the TB/HIV funding request for 2017-2019 made no mention of these populations. The TRP and the Ethiopian country coordinating mechanism went back and forth on this issue during the review of the funding request and during grant-making. The TRP suggested that Ethiopia set up male health clinics where MSM could remain anonymous.

3. NEWS

Implementers of Global Fund grants may not benefit from the services provided by Supreme Audit Institutions in some African countries, according to a study carried out by Aidspan. The research is based on case studies in three countries: Cameroon, Malawi and Rwanda.

4. NEWS

The Global Fund finances HIV grants in 18 countries in Latin America and the Caribbean. All but one of the grants focus on key populations. A report by the Pan American Health Organization and UNAIDS says that the region is too dependent on external financing. It also says that there is a need for detailed plans to transition away from this dependency.

5. NEWS

In their review of the Kenya TB/HIV funding request, the Technical Review Panel and the Grant Approvals Committee applauded the attention paid to key populations and human rights. They also identified several weaknesses and concerns. Four grants emanating from the request were approved by the Board in December 2017.

6. NEWS

The Global Fund Board has approved another $1.22 billion in funding for country grants, bringing the cumulative amount awarded to date to $8.86 billion. A fifth batch was approved on 12 January, consisting of 33 grants emanating from 22 funding requests from 16 countries. Interventions worth $383.3 million were added to the Unfunded Quality Demand Register. Also approved as part of Batch 5 was a multi-country grant for Southern Africa.

7. NEWS

An audit of Global Fund grants to Bangladesh rated them as “partially effective,” the second highest rating in the OIG’s four-tier rating scheme. The Office of the Inspector General said that Bangladesh has made significant progress in the fight against the three diseases, but that problems remain. The audit identified significant program and financial management weaknesses in the national TB program.

8. ERRATUM

We correct two errors in an article on LFA tenders published in GFO 328 on 10 January.

Global Fund Board approves fifth batch of country grants from 2017-2019 allocations, in the amount of $1.22 billion

6. NEWS

23 Jan 2018

Author:

David Garmaise

Cumulative amount awarded to date: $8.86 billion

On 12 January 2018, the Global Fund Board approved 33 country grants worth $1.22 billion. This was the fifth batch of approvals from the 2017–2019 allocations, and brings the cumulative amount awarded to date to $8.86 billion.

The 33 grants were from 22 funding requests submitted by 16 countries. The Board was acting on the recommendations of the Technical Review Panel (TRP) and the Grant Approvals Committee (GAC).

The $1.22 billion total included six matching funds requests valued at $24.2 million. Interventions totaling $383.3 million were added to the Unfunded Quality Demand (UQD) Register. Domestic commitments to the programs represented by the approved grants amounted to $2.29 billion.

For countries using euros, the amounts were converted to U.S. dollars at a rate of 1.2115 euros to the dollar.

The domestic commitments shown are for the disease programs and exclude RSSH unless otherwise indicated.

The amounts approved for Cameroon include $11.3 million from a Government of Spain Debt2Health swap.

The domestic commitment shown for Cameroon TB only reflects the minimum co-financing commitment to be invested in health products.

The UQD and domestic commitments for India TB/HIV were previously shown (under HIV in Batch 4).

The amounts approved for Cameroon HIV include matching funds in the amount of $9,176,325.

As is customary, the approved funding is subject to availability of funding and will be committed in annual tranches. Where more than one grant has been approved for a component, the Secretariat has the authority to redistribute the approved amounts among the grants (except that any material change must be validated by the TRP).

Of the 22 funding requests, four were of the program continuation variety; four were full review; and 14 were tailored. Five of the funding requests were from Window 1 (20 March 2017); 11 from Window 2 (23 May); and six from Window 3 (28 August).

In its report to the Board, the GAC said that the grants were found to be disbursement-ready by the Secretariat after a thorough review process and in consultation with partners. During grant-making, the GAC said, each applicant refined the grant documents, addressed issues raised by the TRP and GAC, and sought efficiencies where possible. The GAC endorsed the reinvestment of efficiencies in one of the following: (a) the same grant, in areas recommended by the TRP; (b) other disease components of the same applicant – where the TRP did not recommend reinvesting in the same grant; or (c) the general funding pool.

Judging by the end dates shown in the GAC report, more than three-quarters of the approved grants had a proposed start date of 1 January 2018. The Secretariat told Aidspan that it was confident most of the confirmations for these grants will be signed very quickly and that few extensions of existing grants will be required. When the grants go to the Board for approval, they are already disbursement ready.

More to come

There were just over 200 country grants approved in the first five batches. Three more windows have been scheduled for 2018, as follows (with the TRP meeting dates shown in parentheses):

In this latest batch of approvals, there was one multi-country grant, known as “Southern Africa WHC.” Submitted by the Southern Africa Regional Coordinating Mechanism, this grant will continue the work of the existing regional grant on TB in the mining sector, with the Wits Health Consortium remaining as PR. The grant has a budget of $22.5 million and covers the following countries: Lesotho, Swaziland, Mozambique, South Africa, Botswana, Namibia, Zambia, Zimbabwe, Tanzania and Malawi. Aidspan plans to publish a separate article on this grant in the near future.

Grant extensions

The Board approved extensions for an HIV grant in Guatemala and two HIV grants in Nigeria.

The Guatemala HIV grant (GTM-H-HIVOS) was extended for 12 months to 31 December 2018 to allow for essential services to continue while a new funding request is reviewed. The TRP reviewed the original request in August 2017 but sent it back for iteration. The extension budget of $4.9 million will come from Guatemala’s 2017–2019 allocation.

HIVOS will be the PR during the extension. Previously, HIVOS was co-PR with the Ministry of Health (MOH), but the MOH has withdrawn. When the new grant is approved, the co-PR is expected to be the Institute for Nutrition of Central America and Panama (INCAP). According to the GAC, the decision to change PR was mainly motivated by the need to lower program costs, promote sustainability, and facilitate coordination with the government. During the extension, the focus will be on providing services to men who have sex with men, and transgendered persons; providing HIV testing; and providing linkage to care for people living with HIV.

The two Nigeria grants (MGA-H-LSMOH and NGA-H-SFHNG) were extended for 18 months. Aidspan previously reported on four other HIV grants that received similar extensions.

Note: The $8.86 billion figure cited in this article for cumulative funding awarded to date is an unofficial figure based on Aidspan’s interpretation of the reports of the Grant Approvals Committee. The $8.86 billion includes matching funds but excludes multi-country grants of the type that used to be called “regional grants” –– except for the Regional Artemisinin-resistance Initiative (RAI) in Southeast Asia. The RAI is a hybrid grant with a total value of $243.7 million, of which $119.0 million comes from the multi-country funding stream in the catalytic investments funding pool; $1.3 million from matching funds; and $123.4 million from country allocations. There is a second type of multi-country grant which covers groupings of small island states; these grants are included in the $8.86 billion figure.

Aidspan reported on the first batch of grant approvals for 2017-2019 here; on the second batch here; on the third batch here; and on the fourth batch here.

Most of the information for this article was taken from Board Document GF-B38-ER05 (Electronic Report to the Board: Report of the Secretariat’s Grant Approvals Committee). This document is not available on the Global Fund website.